Vascular Surgery Practice Questions

Q: Management of subclavian artery injury due to inadvertent central catheter insertion include all of the following except?

Mechanical Compression. **Explanation:** The management of inadvertent subclavian artery cannulation (the "Hoarseness of the Subclavian" or "Big Bore" injury) has shifted away from traditional methods due to the anatomical constraints of the vessel. **Why Mechanical Compression is the Correct Answer (The "Except"):** Unlike the femoral or radial arteries, the **subclavian artery is a non-compressible vessel**. It lies posterior to the clavicle and subclavius muscle, making external manual compression ineffective for achieving hemostasis. Attempting compression often leads to delayed recognition of internal bleeding, resulting in massive hemothorax, tension hemothorax, or compressive mediastinal hematomas. Therefore, "pull and press" is contraindicated for large-bore injuries in this location. **Analysis of Other Options:** * **Closure Devices (A):** Percutaneous suture-mediated or collagen-plug closure devices (e.g., ProGlide) are increasingly used to seal the arteriotomy site upon catheter removal. * **Covering Stent (C):** Endovascular management using a covered stent (stent-graft) is a preferred minimally invasive approach to exclude the injury site while maintaining distal flow. * **Tract Embolization (D):** This involves using prothrombotic agents or coils to seal the tract as the catheter is withdrawn, preventing track-related bleeding. **Clinical Pearls for NEET-PG:** * **Zone of Injury:** Subclavian injuries are difficult to manage surgically because they often require clavicular resection or thoracotomy for proximal control. * **The "Rule of Thumb":** If a large-bore catheter (≥7 French) is inadvertently placed in a non-compressible artery, **do not remove it** until a definitive repair plan (Endovascular or Surgical) is in place. * **Gold Standard:** Endovascular repair is now preferred over open surgery for stable patients due to lower morbidity.

Q: Elgiloy is used in the preparation of which of the following?

Vascular stent. **Explanation:** **Elgiloy** is a specialized non-magnetic cobalt-chromium-nickel alloy originally developed for the watchmaking industry but now widely used in medical therapeutics. **Why Vascular Stents is the Correct Answer:** The primary reason Elgiloy is used in **vascular stents** is its exceptional mechanical properties: high fatigue resistance, high strength, and excellent biocompatibility. Most importantly, it possesses **"shape memory"** characteristics and high elasticity, making it ideal for self-expanding stents. These stents can be compressed for catheter delivery and then reliably expand to maintain vessel patency in peripheral vascular interventions (e.g., iliac or femoral arteries). **Analysis of Incorrect Options:** * **B. Mesh:** Surgical meshes (used for hernia repairs) are typically made of synthetic polymers like Polypropylene, Polyester, or PTFE. Metal meshes are rare and usually made of Titanium or Stainless Steel. * **C. Bone Plates:** Orthopedic implants like bone plates and screws are traditionally made of Stainless Steel (316L) or Titanium alloys. While cobalt-chrome alloys are used in joint replacements (prostheses), Elgiloy specifically refers to the thin, spring-tempered wire/strip form used in stents and dental wires. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Elgiloy consists of Cobalt (40%), Chromium (20%), Nickel (15%), and Molybdenum (7%). * **Nitinol vs. Elgiloy:** While Nitinol (Nickel-Titanium) is the most common shape-memory alloy, Elgiloy is a significant alternative in vascular surgery and orthodontics. * **MRI Safety:** Elgiloy is non-ferromagnetic, making stents made from this material generally **MRI-compatible**. * **Other uses:** It is also frequently used in **orthodontic archwires** and heart valve components due to its corrosion resistance.

Q: What is the most common cause of superficial thrombophlebitis?

Intravenous catheters/infusion. **Explanation:** Superficial thrombophlebitis (STP) is the inflammation of a superficial vein associated with a blood clot. **1. Why Option A is Correct:** In modern clinical practice, **intravenous (IV) catheterization and infusions** are the most common causes of superficial thrombophlebitis. This occurs due to mechanical irritation of the vein wall by the cannula or chemical irritation from the infused medications/fluids (iatrogenic trauma). It most frequently affects the cephalic or basilic veins of the upper limbs. **2. Analysis of Incorrect Options:** * **Option B (DVT):** While STP and DVT share similar risk factors (Virchow’s triad), DVT is a complication or a concurrent finding rather than the primary *cause* of STP. * **Option C (Varicose Veins):** This is the most common **spontaneous** cause of STP in the lower limbs. However, globally and across all hospital settings, IV-induced phlebitis remains more frequent. * **Option D (Trauma):** While physical trauma can lead to vein injury and thrombosis, it is less frequent than the controlled "micro-trauma" caused by millions of IV cannulations performed daily. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mondor’s Disease:** A specific type of superficial thrombophlebitis involving the lateral thoracic or epigastric veins; it presents as a "cord-like" structure on the chest wall. * **Trousseau’s Sign (Migratory Thrombophlebitis):** Recurrent STP at different sites, strongly associated with internal malignancies, most commonly **Carcinoma of the Pancreas**. * **Management:** Most cases are self-limiting. Treatment includes NSAIDs, warm compresses, and elevation. If STP occurs at the saphenofemoral junction, anticoagulation is required to prevent progression to DVT.

Q: A 57-year-old female presented with shoe-claudication. Peripheral aneurysm was suspected. Which of the following is the most common site of peripheral aneurysm?

Popliteal artery. **Explanation:** The **popliteal artery** is the most common site for peripheral arterial aneurysms, accounting for approximately **70–80%** of all peripheral cases. These aneurysms are frequently associated with abdominal aortic aneurysms (AAA); about 50% of patients with a popliteal aneurysm will have a synchronous AAA. Furthermore, they are often bilateral (50–70% of cases). The clinical presentation often involves "shoe-claudication" or distal ischemia due to thrombosis or embolism, rather than rupture. **Analysis of Options:** * **Popliteal Artery (Correct):** As the most frequent site, it is a high-yield fact for surgical exams. It is defined as a dilation >1.5 times the normal diameter. * **Femoral Artery (Incorrect):** This is the second most common site for peripheral aneurysms (specifically the common femoral artery). While significant, it occurs less frequently than popliteal aneurysms. * **Radial and Brachial Arteries (Incorrect):** Aneurysms in the upper extremities are rare. When they occur, they are often "pseudoaneurysms" resulting from trauma or iatrogenic injury (e.g., arterial lines or catheterization) rather than true atherosclerotic aneurysms. **NEET-PG High-Yield Pearls:** * **Rule of 50s:** 50% of popliteal aneurysms are bilateral; 50% are associated with an AAA. * **Most common complication:** Thromboembolism leading to "Blue Toe Syndrome" or acute limb ischemia (Rupture is rare, unlike AAA). * **Diagnosis:** Duplex Ultrasonography is the initial investigation of choice. * **Indication for Surgery:** Symptomatic patients or asymptomatic aneurysms >2 cm in diameter.

Q: Most commonly, varicose veins are seen with which of the following?

Long saphenous vein. **Explanation:** Varicose veins are dilated, tortuous, and elongated superficial veins caused by valvular incompetence and increased venous pressure. **Why Option A is Correct:** The **Long Saphenous Vein (LSV)**, also known as the Great Saphenous Vein, is the most common site for primary varicose veins. This is due to its significant length (the longest vein in the body) and the high hydrostatic pressure it must withstand while draining the medial aspect of the leg and thigh. The most frequent site of valvular failure is the **saphenofemoral junction (SFJ)**, where the LSV joins the common femoral vein. **Why Other Options are Incorrect:** * **Option B:** While the Short Saphenous Vein (SSV) can become varicose (often due to saphenopopliteal junction incompetence), it is statistically less common than LSV involvement. * **Option C:** Although both can be involved simultaneously, the question asks for the "most common" single site, which remains the LSV. * **Option D:** Popliteal and femoral veins are **deep veins**. Varicose veins, by definition, involve the superficial venous system. Incompetence in deep veins leads to Chronic Venous Insufficiency (CVI) or DVT, not primary varicosities. **Clinical Pearls for NEET-PG:** * **Trendelenburg Test:** Used to differentiate between saphenofemoral incompetence and perforator incompetence. * **Gold Standard Investigation:** Duplex Ultrasound (Doppler) is the investigation of choice to map the anatomy and identify reflux. * **Treatment of Choice:** Endovenous Thermal Ablation (Laser/Radiofrequency) has largely replaced traditional "Stripping and Ligation." * **Brodie-Trendelenburg Test:** Specifically identifies the level of valvular incompetence.

Q: What is the most common cause of pulmonary embolism?

Thrombosis of leg veins. **Explanation:** Pulmonary Embolism (PE) is a life-threatening condition caused by the obstruction of the pulmonary arterial system by a detached thrombus. The most common source of these emboli is **Deep Vein Thrombosis (DVT) of the leg veins**, accounting for over 90% of cases. **Why Option B is Correct:** The deep veins of the lower limbs (specifically the popliteal, femoral, and iliac veins) are the primary sites for thrombus formation due to Virchow’s Triad (stasis, endothelial injury, and hypercoagulability). Thrombi formed in these large-caliber vessels are more likely to propagate, detach, and travel through the right heart into the pulmonary circulation. **Why Other Options are Incorrect:** * **Option A (Prostatic veins):** While pelvic vein thrombosis (including prostatic and uterine veins) can cause PE, especially after pelvic surgeries, it is significantly less common than lower limb DVT. * **Option C (IVC thrombosis):** Thrombosis of the Inferior Vena Cava is usually a result of the upward extension of a clot from the iliofemoral veins. Primary IVC thrombosis is rare and not the leading cause of PE. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for DVT:** The calf veins (soleal sinuses); however, **proximal DVT** (above the knee) carries a much higher risk of causing PE. * **Gold Standard Investigation:** CT Pulmonary Angiography (CTPA) is the investigation of choice for PE. * **ECG Finding:** The most common finding is sinus tachycardia; the "classic" S1Q3T3 pattern is specific but seen in fewer than 20% of patients. * **Treatment:** Immediate anticoagulation with Heparin (LMWH or Unfractionated) followed by oral anticoagulants.

Q: What is the gold standard investigation of choice for deep vein thrombosis?

Venography. **Explanation:** The **gold standard** investigation for Deep Vein Thrombus (DVT) is **Ascending Contrast Venography**. This procedure involves injecting a radiopaque contrast medium into a dorsal foot vein and using fluoroscopy to visualize the deep venous system. A diagnosis of DVT is confirmed by the presence of a persistent **intraluminal filling defect** seen in at least two different projections. **Analysis of Options:** * **Venography (Correct):** While it is the definitive "gold standard" due to its high accuracy, it is rarely performed in modern clinical practice because it is invasive, painful, and carries risks like contrast-induced nephropathy or even iatrogenic venous thrombosis. * **Duplex Ultrasound (Incorrect):** This is the **investigation of choice (IOC)** and the first-line screening tool in clinical practice. It has high sensitivity and specificity for proximal DVT but is not considered the "gold standard" because it is operator-dependent and less accurate for calf vein or pelvic thrombi. * **CT/MRI (Incorrect):** CT Venography and MRV are highly accurate and useful for evaluating DVT in the pelvic veins or Vena Cava (where ultrasound is limited), but they are not the established gold standard. **Clinical Pearls for NEET-PG:** * **Investigation of Choice (IOC):** Color Duplex Ultrasound (Non-invasive). * **Gold Standard:** Contrast Venography (Invasive). * **Most sensitive blood test:** D-Dimer (High negative predictive value; used to rule out DVT in low-risk patients). * **Wells Criteria:** Used for clinical probability scoring of DVT. * **Phlegmasia Cerulea Dolens:** A limb-threatening emergency characterized by massive iliofemoral DVT causing total venous occlusion and cyanosis.

Question 1

Sclerotherapy is contraindicated in all of the following conditions EXCEPT:

Accepted Answer

Recurrent varices

Answer

Deep vein thrombosis

Answer

Saphenofemoral incompetence

Answer

Huge varicosities

Question 2

Management of subclavian artery injury due to inadvertent central catheter insertion include all of the following except?

Accepted Answer

Mechanical Compression

Answer

Closure device

Answer

Covering stent

Answer

Tract embolization

Question 3

Elgiloy is used in the preparation of which of the following?

Accepted Answer

Vascular stent

Answer

Mesh

Answer

Bone plates

Answer

All of the above

Question 4

What is the most common cause of superficial thrombophlebitis?

Accepted Answer

Intravenous catheters/infusion

Answer

Deep vein thrombosis (DVT)

Answer

Varicose veins

Answer

Trauma

Question 5

The Brodie-Trendelenburg test is performed to assess for which condition?

Accepted Answer

Sapheno-femoral incompetence

Answer

Deep vein thrombosis

Answer

Varicose veins

Answer

Superficial migratory thrombophlebitis

Question 6

A 57-year-old female presented with shoe-claudication. Peripheral aneurysm was suspected. Which of the following is the most common site of peripheral aneurysm?

Accepted Answer

Popliteal artery

Answer

Femoral artery

Answer

Radial artery

Answer

Brachial artery

Question 7

Which of the following statements is true about mesenteric vein thrombosis?

Accepted Answer

Peritoneal signs are always present.

Answer

Thrombectomy is always performed.

Answer

Heparin is administered.

Answer

Surgery may result in short bowel syndrome.

Question 8

Most commonly, varicose veins are seen with which of the following?

Accepted Answer

Long saphenous vein

Answer

Short saphenous vein

Answer

Both

Answer

Popliteal and femoral vein

Question 9

What is the most common cause of pulmonary embolism?

Accepted Answer

Thrombosis of leg veins

Answer

Thrombosis of prostatic veins

Answer

Inferior vena cava thrombosis

Answer

None of the above

Question 10

What is the gold standard investigation of choice for deep vein thrombosis?

Accepted Answer

Venography

Answer

Double contrast duplex

Answer

CT scan

Answer

MRI

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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